Schneider William Vincent, Bulloch Blake, Wilkinson Matt, Garcia-Filion Pamela, Keahey Laine, Hostetler Mark
Emergency Department, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
J Asthma. 2011 Apr;48(3):248-52. doi: 10.3109/02770903.2011.555036. Epub 2011 Feb 21.
The primary purpose of this study was to determine if portable spirometers can be successfully used in an emergency department (ED) in children with an acute exacerbation of asthma. The secondary purpose of this study was to determine if a validated clinical asthma score (CAS) correlates with the spirometry results in children with an acute exacerbation of asthma.
Children between the ages of 6 and 17 years who presented to an urban free-standing children's hospital ED with an acute exacerbation of asthma were enrolled in our study. On arrival, the CAS was recorded and then portable spirometry was performed. Attempts were continued until acceptable and reproducible flow loop measurements were obtained or until the patient was unable to perform further attempts. Outcomes included success at spirometry and correlation of spirometry with the CAS.
A total of 101 patients were enrolled in this study. Of those patients, only 35 (35%) were able to successfully perform portable spirometry. Successful spirometry attempts were associated with older age (10.4 vs. 8.9, p = .01), lower respiratory rates (24.8 vs. 30.2, p = .001), lower heart rates (110 vs. 124, p = .004), and lower CASs (8.4 vs. 9.7, p = .001). Increasing asthma severity correlated with a decreased likelihood of successfully obtaining a useful forced expiratory volume in 1 second (FEV(1)) measurement (p = .013). Compared with cases of mild asthma, a patient with moderate asthma is 33% less likely to be able to perform spirometry, and a patient with severe asthma 93% less likely to perform spirometry. The CAS correlated poorly with the more objective measure of FEV(1)% predicted in those with mild asthma.
Many children are incapable of using portable spirometry for the evaluation of acute exacerbations of asthma in the ED. The clinical asthma scoring system demonstrated poor correlation with portable spirometry measurements in terms of severity classification.
本研究的主要目的是确定便携式肺活量计能否成功用于急诊科（ED）哮喘急性加重期的儿童。本研究的次要目的是确定经过验证的临床哮喘评分（CAS）与哮喘急性加重期儿童的肺活量测定结果是否相关。
年龄在6至17岁之间、因哮喘急性加重期就诊于一家城市独立儿童医院急诊科的儿童纳入本研究。到达后，记录CAS，然后进行便携式肺活量测定。持续尝试，直到获得可接受且可重复的流量环测量结果，或直到患者无法进行进一步尝试。结果包括肺活量测定的成功情况以及肺活量测定与CAS的相关性。
本研究共纳入101例患者。在这些患者中，只有35例（35%）能够成功进行便携式肺活量测定。成功的肺活量测定尝试与年龄较大（10.4岁对8.9岁，p = 0.01）、呼吸频率较低（24.8次/分钟对30.2次/分钟，p = 0.001）、心率较低（110次/分钟对124次/分钟，p = 0.004）以及较低的CAS（8.4对9.7，p = 0.001）相关。哮喘严重程度增加与成功获得有用的1秒用力呼气量（FEV₁）测量值的可能性降低相关（p = 0.013）。与轻度哮喘病例相比，中度哮喘患者进行肺活量测定的可能性低33%，重度哮喘患者进行肺活量测定的可能性低93%。在轻度哮喘患者中，CAS与更客观的预测FEV₁%测量值的相关性较差。
许多儿童无法在急诊科使用便携式肺活量计评估哮喘急性加重期。临床哮喘评分系统在严重程度分类方面与便携式肺活量测定结果的相关性较差。
